Doctors, Apologies – People are People on Both Sides of the Border

Unlike the other work I do, this blog crosses the border, back and forth, between Canada and the US. You may not realize it, but our host, Hart and the HEN Network, is based in Canada. What I enjoy about my participation here is that it encourages me to think more globally than I typically do with my US-focused work. (thanks Hart!)

I explain all that today because news a few weeks ago about what the laws in Canada will allow, or not allow regarding the legal permission for Canadian doctors to apologize to patients for mistakes they have made, forced me to think of doctors and their apologies on a much broader basis.

You see — to this point, the question about doctors apologizing for their mistakes has never really been about right and wrong. The question has been about lawsuits. No matter where in the world a doctor harmed a patient, regardless of that doctor’s intention, the problem is never about the mistake or the mistake’s medical results. No, the question becomes one of whether the doctor can be sued, and how much money the lawyers will make in the process.

Let’s consider point of view for a moment:

When a patient has been hurt by the mistakes of a doctor, or if a patient has died and the family is left to grieve, then dealing with that hurt or grief happens first. But, like suffering from any error, we also look for places to lay the blame, as if finding the right target will help us handle the suffering better. THAT’s a basic of human nature — looking to offload our pain on to someone or something else. The next step is to expect that whomever we have blamed will at least own up to it — take responsibility for causing our pain and suffering.

And so (foolishly, perhaps) we expect an apology. An apology is the evidence that the doctor is taking that responsibility, and feels remorseful. Hearing a doctor say “I’m sorry” means we can now give up some of the pain and hurt because we know that the perpetrator has now taken some of that onto his/her shoulders.

[And, as an aside, please know that when I write this, I do so from my own experience. Having suffered a heinous misdiagnosis, and then, years later, having benefited from an apology. This is REAL personal, and very few people understand it as well as I do.]

From the doctor’s point of view — we can only imagine how difficult the situation is for them, because, until the past few years, doctors were taught never to apologize. Not only could they not apologize, they weren’t even allowed to disclose an error had been made! That was true in the US, Canada and other corners of the world. And yes, you know why. They could not apologize because that would give the patient or the patient’s family the evidence they needed to prove malpractice in a court of law. the policy even had a name, “Shut Up and Fight.”

Now, we know of course, for some doctors that was OK. We all know doctors with egos so large that there’s no room to admit they’ve made a mistake. THEY would never make a mistake! The problem was something the patient did wrong! Not only that, they don’t report other doctors’ mistakes either… they cover up for their colleagues, perhaps believing “there but for the grace of God…”

But for many doctors, and I believe the great majority of them, not being able to apologize was just as problematic for them as it was for the patient or his/her family. How do you sleep at night when you know you’ve killed someone, or caused them a lifetime of medical problems or debilitation? Being able to apologize would help them conquer some of their grief, too….

Then, just a few years ago, the University of Michigan did an informal study within its own academic hospital system, letting its doctors apologize for adverse events, and arrived at a startling (to them) result. The amount of money asked for in lawsuits dropped to one-third what it had been before.

Fast-forward — it’s six years later and — finally — doctors are being encouraged to apologize for their mistakes. On both sides of the US –Canada border. Mind you — it’s not for the cathartic or value-driven reasons — but for the money. More apologies = fewer lawsuits.

But in this case, it’s win-win for patients, doctors and the hospitals or other organizations involved in mistakes. Patients get the relief that comes from off-loading some of their pain to the apology. Doctors and others involved get the relief that comes from addressing their value systems and their need to offload some of their guilt by apologizing.

Now the laws are following the studies. Many states in the US, and now several provinces in Canada are allowing doctors to apologize without fear that their apologies will affect lawsuit outcomes. And yes, it seems that fewer lawsuits are being filed.

So yes. Everyone wins when a doctor is allowed to apologize. Well, except for the lawyers. Fewer lawsuits would mean less work for them, I suppose.

Well. OK. Maybe that means the ability of doctors to apologize is even sweeter?

Learn more about doctors and apologies for adverse events at Sorry Works.

Comments

I am a doctor from another country and I read your articles to know more about patients’ concerns about healthcare. I know that healthcare systems have so many flaws, even in our country that is why i don’t blame patients who get angry or upset or even appear demanding even at their first physician visit. Yes, bottomline is both patients and doctors are human beings that get hurt and commit mistakes. Apology should never be a concern about lawsuits or money but about being humble, that doctors are not perfect and patients too need service. What we all want to understand is that studying medicine is really hard. You enter medschool with a goal to help and serve the sick but during the course, you are battered physically and emotionally both from the demands of your patients and yourself. I never wanna be wrong about anything especially at work (no-room-for-error-attitude), that is why it is very frustrating if at times, i failed to think about this or i wish i thought of that. It’s psychologically draining. And i learned that in the US, doctors are in debt when they start practicing since studying medicine there is really expensive. That’s an added burden to their thoughts. And I bet their families too are making sacrifices for their busy schedules or financial problems. There is a great shortage in doctors to date. And I expect that it will still rise. People in medical field or not, or even doctors themselves are very discouraging. Even before i enter medschool, people are trying to stop me not only because i’m a woman, but because being a doctor is expensive, robs up your time with your family and has so much responsibility. At that time, i thought, why do people discourage someone who wants to help others? Don’t they need doctors when they get sick? That incident had driven me even more to becoming a doctor. But after everything that i have been through, i regret to say that sometimes i wish that i could have taken the other route. I really feel unappreciated. Medicine is not an exact art. And that should be realized by both parties. Doctors can be patients too, and we know how hard it is to get sick and to put your trust to another human being. That’s why i ask you to pray for your doctors. Its just a simple thing but i believe it will make a difference. Patients and doctors should work hand in hand with trust and respect. Human beings can’t “heal”, patients and doctors alike should realize that.

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